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Treponema Pallidum (Syphilis) www.nature.com/scientificreports OPEN Treponema pallidum (syphilis) antigen TpF1 induces angiogenesis through the activation of the IL-8 Received: 16 July 2015 Accepted: 26 November 2015 pathway Published: 05 January 2016 Tommaso Pozzobon1,*, Nicola Facchinello1,*, Fleur Bossi2,*, Nagaja Capitani3,4, Marisa Benagiano4, Giulietta Di Benedetto5,6, Cristina Zennaro2, Nicole West2, Gaia Codolo1, Marialina Bernardini7, Cosima Tatiana Baldari3, Mario Milco D’Elios4, Luca Pellegrini8, Francesco Argenton1 & Marina de Bernard1 Over 10 million people every year become infected by Treponema pallidum and develop syphilis, a disease with broad symptomatology that, due to the difficulty to eradicate the pathogen from the highly vascularized secondary sites of infection, is still treated with injections of penicillin. Unlike most other bacterial pathogens, T. pallidum infection produces indeed a strong angiogenic response whose mechanism of activation, however, remains unknown. Here, we report that one of the major antigen of T. pallidum, the TpF1 protein, has growth factor-like activity on primary cultures of human endothelial cells and activates specific T cells able to promote tissue factor production. The growth factor-like activity is mediated by the secretion of IL-8 but not of VEGF, two known angiogenic factors. The pathogen’s factor signals IL-8 secretion through the activation of the CREB/NF-κB signalling pathway. These findings are recapitulated in an animal model, zebrafish, where we observed that TpF1 injection stimulates angiogenesis and IL-8, but not VEGF, secretion. This study suggests that the angiogenic response observed during secondary syphilis is triggered by TpF1 and that pharmacological therapies directed to inhibit IL-8 response in patients should be explored to treat this disease. Syphilis is a sexually transmitted disease that is caused by the spirochetal bacterium Treponema pallidum. It affects over 10 million people every year and in the past 15 years its spread has increased in North America and in Central and Eastern Europe1. Syphilis is a multistage disease; after the first stage in which a red papule appears and ulcerates the site of inoculation, the bacterium penetrates through the genital mucosa and enters the lymphatic and blood stream, to disseminate into other organs and cause a plethora of clinical manifestations typically defined as secondary syphilis; however, the most common manifestation of secondary syphilis is a disseminated muco-cutaneous rash, characterized by vascular inflammation and increased angiogenesis2,3. It is widely assumed that angiogenesis could have a crucial role in syphilis pathogenesis for two main reasons. First, the bacterium has limited metabolic capabilities4; this implies that the pathogen requires support from the host to derive essential nutrients; second, the microorganism could take advantage of the vascular leakage to gain access to the bloodstream and spread to other parts of the patient’s body. Compared to normal skin, highly vascularized cutaneous lesions from patients with diagnosed secondary syphilis show that the level of expression of the vascular endothelial growth factor (VEGF) is only minimally affected5. This suggests that VEGF may not be the major factor involved in the T. pallidum-induced angiogenesis. 1Department of Biology, University of Padua, Padua, Italy. 2Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy. 3Department of Life Sciences, University of Siena, Siena, Italy. 4Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 5Institute of Neuroscience, Italian National Research Council (CNR), Padua, Italy. 6Venetian Institute of Molecular Medicine, Padua, Italy. 7Department of Biology and Biotechnology, Sapienza University of Rome, Rome, Italy. 8Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec, Canada. *These authors contributed equally to this work. Correspondence and requests for materials should be addressed to F.A. (email: [email protected]) or M.d.B. (email: [email protected]) SCIENTIFIC REPORTS | 6:18785 | DOI: 10.1038/srep18785 1 www.nature.com/scientificreports/ Figure 1. TpF1 induces proliferation and migration of endothelial cells and their organization in microcapillary-like structures. (a) HUVECs were exposed to TpF1, VEGF (positive control) or vehicle (saline). After 12 h, cells were counted and normalized to the number of plated cells set as 1 arbitrary unit (A.U.). The graph shows cell proliferation under the different conditions. Data are represented as the mean ± S.D. of three independent experiments. (b) Fast DiI-labelled HUVECs were seeded on the upper chambers of 24-transwell plates. TpF1, VEGF, or vehicle, were added to the lower chambers. Migrated cells SCIENTIFIC REPORTS | 6:18785 | DOI: 10.1038/srep18785 2 www.nature.com/scientificreports/ were quantified after 2 and 6h by a microplate reader and expressed as % of seeded cells. Data are presented as mean ± S.D. of three independent experiments. (c) HUVECs were seeded on Matrigel-coated coverslips and exposed to TpF1, VEGF or vehicle, for 12 h. Cells were stained with Phalloidin-Alexa Fluor 546 and analyzed by confocal microscopy at 200 × magnification. Scale bar = 300 μ m. This observation is not surprising: although the VEGF family has long been considered crucial in the regulation of angiogenesis, other factors have been identified as pro-angiogenic, including chemokines belonging to the CXC family such as CXCL2 and IL-8/CXCL86. These chemokines could be produced either by endothelial cells or by resident and infiltrating inflammatory cells, such as macrophages that accumulate in the muco-cutaneous lesions of secondary syphilis7. To date, however, the factor that stimulates the proliferation of endothelial cells and the forma- tion of new blood vessels remains unknown. Thus, the search for the pathogenic factor that triggers angiogenesis in syphilis patients remains an outstanding goal in translational medicine due to its potential as a therapeutic target. Infiltration of inflammatory cells in the wall of the vessels around the lesions is a histological change that also characterizes tertiary syphilis; typically, the lesions at this stage can degenerate to extensively damage the arterial wall, or to cause atheromatosis. Indeed, relative common causes of death in patients with inadequately treated tertiary syphilis are aneurysm and thrombi that grow on the atherosclerotic plaques8. Again, the pathogenic factor that triggers this response is not known. The fact that syphilis is a chronic infection probably reflects the ability of the bacterium to elicit a T regulatory response, which could be associated with fading of the host effector immune response against the pathogen9. We have recently demonstrated that TpF1, a major antigen of T. pallidum, plays a pivotal role in driving this suppressive immune response by modulating the release of specific cytokines by monocytes10. TpF1 is a protein that shares homology with another immunomodulant antigen, the neutrophil activating protein (HP-NAP), produced by the bacterium Helicobacter pylori. Both these proteins belong to the DNA-binding proteins from starved cells (Dps)-like family, a group of bacterial proteins with a dodecameric structure11. Similar to HP-NAP, TpF1 interacts with neutrophils and monocytes to modulate their activity10,12. In this study, we used in vitro, cell based and zebrafish genetics approaches to interrogate the role of TpF1 in syphilis. Our data show that TpF1 stimulates proliferation and migration of endothelial cells and that this effect depends on IL-8 secretion. In addition, we mapped the pathway that activates IL-8 secretion and proved the angio- genic activity of TpF1 in an animal model system, zebrafish. We also report that TpF1 elicits a specific T cell response in syphilis patients: such a response exerts a helper function for endothelial cells that acquire a pro-inflammatory profile and release tissue factor (TF), the molecule that triggers the coagulation cascade. Results Recombinant TpF1 has growth factor-like activity. We started to investigate the growth factor-like activity of TpF1, a major antigen expressed by T. pallidum10, by comparing the proliferative rate of human umbilical vein endothelial cells (HUVECs) exposed to recombinant TpF1 or VEGF (free of Gram-positive and Gram-negative bacterial contaminants; Suppl. Fig. S1). Data showed that TpF1 stimulates cell proliferation at a rate that is compa- rable to that of VEGF (Fig. 1a). We then moved to compare the effect on cell migration by using a Transwell model system. Again, results showed a pro-migratory effect of TpF1 similar to that of VEGF (Fig. 1b). We next evaluated the ability of TpF1 to induce the tubular organization that is typically observed upon VEGF stimulation and that is widely accepted to reflect the acquisition of a vessel-like phenotype13. Unlike control cells, in this assay, both VEGF and TpF1 stimulate the cells to elongate and to develop spatially organized connections (Fig. 1c). We conclude that local secretion of bacterial TpF1 in vivo might have VEGF growth factor-like activity in endothelial cells. TpF1 activity is mediated by IL-8. One possible mechanism that could explain the VEGF-like activity of TpF1 is that the bacterial factor could induce VEGF expression per se which, in turn, would activate endothelial cell proliferation, migration, and angiogenesis-like differentiation
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